Transitional Care

  • Lucy Gossens
  • Judy AmmerlaanEmail author
Part of the In Clinical Practice book series (ICP)


Transitional care is a purposeful, planned process addressing the medical, psychosocial and educational/vocational (holistic) needs of adolescents and young adults as they move from child-centred to adult-oriented healthcare systems. From the perspective of young peoples with juvenile onset rheumatic and musculoskeletal diseases (RMDs), the “health transition” is just one part of the wider set of educational, personal, family and social transitions they make during adolescence. Transition should never be considered as the event of transfer between paediatrics and adult care but as a holistic, age- and developmentally appropriate process. A number of key elements, including the active involvement of AYA themselves, are recognized to be important in transition and are detailed in this chapter.


Key components of transition Transition coordinator Multidisciplinary team Implementation 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University Medical Centre Utrecht, Department Rheumatology and Clinical ImmunologyUtrechtThe Netherlands

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